1. Regional Epi Meeting – Hepatitis B Vaccine Pilot Colandra Holiday, Vic Landa, Whitney Griffith TN Dept. Health – Regional Epi Meeting April 29, 2014

2. Overview Purpose:  Reduce the incidence of adults that become infected with hepatitis B virus (HBV) Goal:  Achieved through vaccination of high-risk adults… …seeking STD services in 38 county health department clinics …incarcerated in select county jails 2

3. Participating Sites STD services in public health clinics  Memphis/Shelby Packer STI Clinic  Upper Cumberland Region (UCR)  East TN Region (ETR)  Northeast Region (NER) County jails  East TN Region (ETR)  Northeast Region (NER) 3

4. East TN Region (ETR) – Jails 4 initial sites recruited, clinics established (Claiborne, Hamblen, Campbell, Blount) 2 additional sites identified for future clinics (Sevier & Anderson) 4

5. East TN Region (ETR) – Jails 5 Timeframe Oct 2013 – April 2014

6. East TN Region (ETR) – Jails 6 Timeframe Oct 2013 – April 2014

7. Northeast Region (NER) – Jails 5 initial sites recruited, clinics established (Washington, Greene, Johnson City, Hancock, Johnson) 3 sites recruited, 1 st clinic pending (Carter, Unicoi, Hawkins) 7

8. Northeast Region (NER) – Jails 8 Timeframe Oct 2013 – March 2014

9. Northeast Region (NER) – Jails 9 Timeframe Oct 2013 – March 2014

10. Vaccination* – Jails (ETR/NER) 10 * Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013 **Completion rates underrepresented

11. Accomplishments – Eastern TN Additional staff dedicated to project Data collection tools  Risk factor questionnaires, REDCap Vaccination efforts implemented in…  …most public health clinics across region  …10 county jails across 2 regions, with 4 additional sites pending Tracking of evaluation metrics required by CDC 11

12. Pilot Support – Eastern TN Public health clinics & county jails  Vaccine inventory  Risk assessment questionnaires  Assisting staff with administrative clinic support  Providing & sending reminder cards County Jails  Data entry (PTBMIS, REDCap) 12

13. Pilot Challenges – Eastern TN Tracking of Doses Administered  Having access to PTBMIS to view all supported regions from one access point  Not all records are loaded into TWIS from PTBMIS  PTBMIS does not retrieve all data from TWIS 13

14. Vaccination – Packer STI Clinic Experience gained from previous hepatitis B vaccine efforts  Offer of vaccine made part of nurse chart audit  Recognition of nurses with most doses given 14

15. Vaccination – Packer STI Clinic Addition of Fast Track STI services – a unique opportunity  Patients without symptoms or exposure seen by M.A. only  Patients offered urine GC/chlamydia and HIV/RPR  Call back in 7 business days for results from hotline 15

16. Vaccination – Packer STI Clinic Introduction of new program  Designated RN hired to recruit and educate patients  Fast Track patients referred from the M.A. to the hepatitis B nurse  Patients for standard services referred from nurse after exam completed  Hepatitis B nurse enters information into REDCap and provides follow-up calls for subsequent doses. 16

17. Vaccination – Packer STI Clinic Lessons learned  Designated nurse integral to program success Month prior to program introduction – 8 doses given. Month after inception – 137 doses given. Compliance with completion of series more than doubled with designated nurse making reminder calls. Patients seen by the designated nurse rarely refuse vaccination once educated 17

18. Vaccination – Packer STI Clinic Lessons learned (cont.)  Special education efforts help Vaccine education posters in waiting room and exam rooms Vaccine information video created and shown in waiting room 18

19. Vaccination* – STD Services 19 * Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013 **Completion rates underrepresented

20. ARE WE REACHING OUR HIGH-RISK POPULATION? 20

21. Population Characteristics*

26. Reported Risk Factors*

29. Questions 29

30. Contact Information – Central Office: Jennifer Ward, MS  Epidemiologist, Viral Hepatitis Team Lead  jennifer.ward@tn.gov jennifer.ward@tn.gov  615-253-8662 Dana Jackson, BSN  RN, Viral Hepatitis Prevention Coordinator  Dana.jackson@tn.gov Dana.jackson@tn.gov  615-253-1361 30

31. Contact Information – Satellite Office: Whitney Griffith,  RN, Hepatitis B Coordinator  whitney.griffith@tn.gov whitney.griffith@tn.gov  865-549-5277 Henning “Vic” Landa, MBA  Administrative Service Assistant  vic.landa@tn.gov vic.landa@tn.gov  865-549-5282 31

32. Contact Information – Memphis: Colandra Holliday, xxx  RN, Hepatitis B Coordinator  colandra.holiday@shelbycountytn.gov colandra.holiday@shelbycountytn.gov  901-222-9356 Donna Freeman, FNP-BC  RN, Nurse Supervisor  Donna.freeman@shelbycountytn.gov Donna.freeman@shelbycountytn.gov  901-222-9417 32